Timely Documentation of CPR Codes and Medical Treatment Preferences in the EHRs of Nursing Homes

Context: Timely documentation of cardiopulmonary resuscitation (CPR) code and medical treatment preferences in electronic health records (EHR) is important for translating advance care planning conversations into actionable medical orders. Objectives: To examine documentation rates of CPR code and medical treatment preferences within the recommended first six weeks of admission in Dutch nursing homes (NHs) from 2017 to 2022. Methods: This retrospective cohort used EHR from 74 Dutch NHs. We assessed the prevalence of documented CPR codes and medical treatment preferences within six weeks of admission, and the median days until first documentation. To examine whether timely documentation odds improved annually, logit generalized estimating equation models -accounting for clustering of residents within NHs– were used, stratified by NH care type, and adjusted for resident factors. Results: We included 163,180 residents. CPR code and medical treatment preferences was documented within 6 weeks of admission for 88% and 64% of the residents, respectively. The median time to first documentation were 0.5-2 days across care types. Overall, between 2017 and 2022, timely documentation of CPR code increased from 82% to 92% and for medical treatment preferences from 56% to 70%. Recent admission year was associated with higher odds of timely documentation for both type of orders in psychogeriatric and somatic care, and for CPR in rehabilitation care. Conclusion: Most residents had documented CPR code and medical treatment preference within the recommended six weeks of admission, with rates improving from 2017 to 2022. The improvement coincided with a national quality indicator introduced in 2018 and the COVID-19 pandemic.